Use of Hemodiafiltration in Children

Fischbach, Michel

doi:10.1111/j.1525-139x.1994.tb00803.x

Cited by 7 publications

(13 citation statements)

References 11 publications

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“…Moreover, hemodiafiltration [17] offers an optimal blood purification capacity. On-line hemodiafiltration [19] with ultra-pure dialysate should limit chronic inflammatory state [25] in hemodialyzed patients and, thereby, allow better nutrition and growth outcome [1,25].…”

Section: Discussionmentioning

confidence: 99%

“…In fact, high predialysis phosphorus serum levels are related to a poor prognostic patient outcome [13][14][15][16]. To achieve, at best, these goals [17][18][19], we applied on-line hemodiafiltration and thereby proposed an intensified and daily dialysis program to our patients. Such a procedure of enhanced dialysis dose has been able to improve the statural growth in children undergoing chronic dialysis [8][9][10].…”

Section: Introductionmentioning

confidence: 99%

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Intensified and daily hemodialysis in children might improve statural growth

Fischbach¹,

Terzic²,

Menouer³

et al. 2006

Pediatr Nephrol

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In children conventional hemodialysis does not often improve growth. We determined linear growth in five children on in-center intensified and daily hemodialysis (IDd) regimen, with a mean age of 8 years 7 months at enrollment. Four of five were on growth hormone started for a median of 28.5 months before IDd. IDd was delivered 5 to 6 times weekly, for three hours each session. Mean follow up of IDd was 18.6 months. Dropout from IDd was kidney transplantation (n=4) or transfer to another center (n=1). IDd and free diet improved appetite, thereby protein intake, was above 2 g/kg/BW. Median weekly Kt/V(urea) was 9.1 (8.7 to 10.4). Predialysis phosphorus blood levels were higher at the start (2.04+/-0.34 mmol/L) than at end of IDd (1.39+/-0.41 mmol/L) without need for carbonate of calcium in four of five cases. During conventional dialysis ht SDS decreased from -0.8 to -1.44, which occurred predominantly before rhGH start. Conversion to IDd significantly increased growth velocity to a mean of 13 cm/year (10.3-18) with a mean change of +1.84 ht SDS/year (0.4 to 2.7). This preliminary report suggests the potential efficacy of IDd regimen in promising growth velocity, either directly from a higher dialysis dose or indirectly through an improved nutritional status.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Intensified and daily hemodialysis in children might improve statural growth

Fischbach¹,

Terzic²,

Menouer³

et al. 2006

Pediatr Nephrol

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“…Using on-line HDF enables the addition of a pre-determined convective dialysis dose to the urea dialysis dose [16,23]. Due to the effects of hemofiltration, tolerance of the dialysis session is improved [3,4,10,16].…”

Section: Dialysis: Diffusion Convection and Combination Therapymentioning

confidence: 99%

“…Hemodiafiltration (HDF), which uses a combination of hemofiltration (HF) and hemodialysis (HD), was initially described in adults in 1977 [1,2] and later used in children in the early 1980s [3,4]. Recent advances in technology [5][6][7] have enabled its use as a [8,9] safe routine renal replacement therapy.…”

Section: Introductionmentioning

confidence: 99%

“…When performed on a daily basis [16,17], HDF offers an "optimal stimulus package" for promoting growth in children [18,19]. Nevertheless, despite its feasibility in children [3,4,16], its interest is mostly based on one center experience [3,4], therefore most pediatric dialysis units worldwide still perform hemodialysis using highly permeable membranes. Indeed, only certain regulatory authorities throughout the world (all of which are in Europe), allow the use of on-line HDF.…”

Section: Introductionmentioning

confidence: 99%

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Hemodiafiltration: the addition of convective flow to hemodialysis

et al. 2011

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Hemodiafiltration (HDF) combines both hemofiltration (HF) and hemodialysis in the same procedure. It was initially performed in adults in 1977, and later used in children in the early 1980s. The use of HDF allows a determined convective dialysis dose to be combined with the conventional urea dialysis dose. The dialysis session is better tolerated as a result of the effects of hemofiltration. On-line HDF, i.e., substitution fluid prepared from ultrafiltration of the ultrapure dialysate, can be performed safely due to recent advances in modern technology. However, despite interest and feasibility in children, the majority of pediatric dialysis units across the world still perform hemodialysis using highly permeable membranes, allowing back filtration in the filter and therefore a degree of convective flow, i.e., internal hemodiafiltration. In some countries, government restrictions prohibit the use of on-line hemodiafiltration, (such as the FDA recommendations in North America), and therefore it should not be used in these circumstances.

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Hemodialysis in children: general practical guidelines

Fischbach¹,

et al. 2005

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Over the past 20 years children have benefited from major improvements in both technology and clinical management of dialysis. Morbidity during dialysis sessions has decreased with seizures being exceptional and hypotensive episodes rare. Pain and discomfort have been reduced with the use of chronic internal jugular venous catheters and anesthetic creams for fistula puncture. Noninvasive technologies to assess patient target dry weight and access flow can significantly reduce patient morbidity and health care costs. The development of urea kinetic modeling enables calculation of the dialysis dose delivery, Kt/V, and an indirect assessment of the intake. Nutritional assessment and support are of major importance for the growing child. Even if the validity of these "urea only" data is questioned, their analysis provides information useful for follow-up. Newer machines provide more precise control of ultrafiltration by volumetric assessment and continuous blood volume monitoring during dialysis sessions. Buffered bicarbonate solutions are now standard and more biocompatible synthetic membranes and specific small size material dialyzers and tubing have been developed for young infants. More recently, the concept of "ultrapure" dialysate, i.e. free from microbiological contamination and endotoxins, has developed. This will enable the use of hemodiafiltration, especially with the on-line option, which has many theoretical advantages and should be considered in the case of maximum/optimum dialysis need. Although the optimum dialysis dose requirement for children remains uncertain, reports of longer duration and/or daily dialysis show they are more effective for phosphate control than conventional hemodialysis and should be considered at least for some high-risk patients with cardiovascular impairment. In children hemodialysis has to be individualized and viewed as an "integrated therapy" considering their longterm exposure to chronic renal failure treatment. Dialysis is seen only as a temporary measure for children compared with renal transplantation because this enables the best chance of rehabilitation in terms of educational and psychosocial functioning. In long term chronic dialysis, however, the highest standards should be applied to these children to preserve their future "cardiovascular life" which might include more dialysis time and on-line hemodiafiltration with synthetic high flux membranes if we are able to improve on the rather restricted concept of small-solute urea dialysis clearance.

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Use of Hemodiafiltration in Children

Cited by 7 publications

References 11 publications

Intensified and daily hemodialysis in children might improve statural growth

Intensified and daily hemodialysis in children might improve statural growth

Hemodiafiltration: the addition of convective flow to hemodialysis

Hemodialysis in children: general practical guidelines

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